"This has been the one biggest changes we've seen so far," said Sid Sczygelski, senior vice president of finance and the chief financial officer for Aspirus Inc., about the federal Affordable Care Act's effect on the hospital's bottom line.

The Affordable Care Act, also known as Obamacare, helped reduce the number of people without health insurance, which meant hospitals saw less bad debt and charity cases last year. In 2014, taxpayers were required for the first time to get insurance or pay a fine.

The $3.2 million savings refer to the Wausau hospital, but other hospitals in the Aspirus system have seen similar savings.

"It will, overall, lower the cost of care over time, because more people are covered," Sczygelski said. Those savings on some health care costs might work their way into the system next year, Sczygelski said, but he wasn't able to quantify the changes yet.

Other hospitals in the area aren't seeing the same savings — but they could have if Gov. Scott Walker had chosen to expand Medicaid with federal assistance as recommended in the Affordable Care Act. Instead, Wisconsin shifted coverage. So all people making up to 100 percent of the federal poverty level are covered by Medicaid, and others — near the poverty threshold, and some who recently qualified for Medicaid — are expected to purchase health insurance through the online marketplace.

Poverty level for an individual is a $11,670 annual income, or $23,850 for a family of four. If Medicaid were expanded to the recommended level in Wisconsin, it would cover individuals making up to $16,105 and four-member families up to $32,913 a year.

Leaders at Aspirus and Ministry Health Care had hoped for the full Medicaid expansion.

"The key is to have the opportunity for people to get insurance," said Jeffrey Francis, chief administrative and financial officer for Ministry Health Care. "The state of Wisconsin didn't expand Medicaid as some other states did. That would have allowed more people to have insurance in the communities that we serve. That would have been an even better outcome."

Jeffrey Francis(Photo: Contributed photo)

The Affordable Care Act was designed to reduce the amount hospitals pay for uncompensated care, but a Supreme Court decision that allowed states to choose whether to expand Medicaid threw that into limbo, said Marty Finkler, an economics professor at Lawrence University in Appleton.

Local hospitals save money because they have less bad debt and charity care, but they also have more expenses through an influx of new Medicaid patients. For Ministry Health Care, the changes cancel each other out.

Medicaid, which is funded with federal and state dollars, does not fully reimburse hospitals and other providers for the cost of service.

"Most of that care has shifted to Medicaid, but we only get 20 cents on the dollar for that," Sczygelski said.

In the Ministry Health Care system, which includes 15 hospitals and 45 clinics in Wisconsin, charity care declined by $12.5 million and bad debt declined by $10 million in the last six months of 2014. But $22 million in new Medicaid losses mean the system pretty much breaks even.

"The reductions in uncompensated care are being offset by the increase in Medicaid that we're seeing in our clinics and our hospitals," Francis said.

These changes are the biggest that Francis and Sczygelski have seen since the Affordable Care Act began to unfold. Finkler said not all of the 2014 data is in yet, and it's still too early for much analysis.

On a smaller level, Sczygelski said Aspirus has seen more people under age 26 come in for services because the law allows them to stay on their parents' insurance. And the new Medicaid patients coming in are often childless adults, many of whom have chronic health issues and mental illnesses.

As the Affordable Care Act continues to take root, Francis said Ministry Health System will continue on as it has, trying to increase quality and reduce waste.

"We will continue to have challenges with the rest of the industry on the cost of health care," Francis said. And as for the poor and vulnerable, Francis said, "we will continue to see those patients, because it fits with our mission."

Nora G. Hertel can be reached at 715-845-0665. Find her on Twitter as@nghertel.